29-03-2025
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SRIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[25-03-2025 17.25] PPM 1: Afternoon session:
55M with motor polyneuropathy raising the suspicion of Guillain Barre syndrome.
Also has noticeable tachypnoea with a respiratory rate of 30.
Past history of tuberculosis visible as old fibro-cavitory lesions in his right upper lobe along with a large lobar consolidation in right lower lobe
Also as you may notice in his knees the typical non metabolic syn knee OA particularly genu valgum that characterizes Narketpally syndrome!
[25-03-2025 17.31] PPM 1: Right upper lobe fibro-cavitary changes (because - old TB) with right lower lobe consolidation (infection possible)
[25-03-2025 17.33] PPM 1: 1) Motor polyneuropathy, suspected Guillain-Barré Syndrome (GBS).
2) MSK Genu valgum with knee OA, possibly linked to Narketpally syndrome.
3) Tachypnea (RR = 30), high risk of respiratory compromise.
[29-03-2025 09.37] PPM 1: Yesterday's afternoon session update of this patient with suspected Guillain Barre quadriparesis and unexplained tachypnoea (unexplained on Tuesday session)
Appears that the patient was slowly developing a painless myocardial infarction even as we discussed on Tuesday although looking at his ECG taken prior to that day there was no inkling of myocardial infarction although there was enough pulmonary edema in his Hrct lungs that I assumed was already YouTubed and archived here (but it was a wrong assumption that I shall try and rectify asap now)
Here's his serial ECGs from 24/3/25
[29-03-2025 09.43] PPM 1: For his acute pulmonary edema that we now realise is part of his myocardial infarction other than the association of his acute kidney injury AKI with a high serum creatinine to the tune of 5, which I skipped mentioning on Tuesday afternoon, he was taken for a session of hemodialysis followed by peritoneal dialysis PD yesterday (@PPM2 @~PPM3 did you ever see PD being done in our hospital while you were here?
[29-03-2025 09.45] PPM 1: 👆This broken hemodialyzer is part of a second product discovery project if you can recall @~PPM4 @PPM2 that we probably abandoned. On Thursday afternoon this was used as usual to introduce the PGY1s to understand the rudiments of hemodialysis.
[29-03-2025 09.50] PPM 1: In view of his AKI and acute peripheral neuropathy we thankfully didn't have to discharge and refer him to Gandhi hospital for iv IG toward addressing the guillain barre diagnosis but he could rest here in the comfort of the association between uremia and its causal association with acute peripheral polyneuropathy
https://pmc.ncbi.nlm.nih.gov/articles/PMC5501032/#:~:text=Rapidly%20progressing%20acute%20peripheral%20neuropathy,commonly%20in%20the%20lower%20extremities.&text=Our%20patient%20harbored%20CKD%20and,concordance%20with%20the%20renal%20parameters.
This case also highlights the importance of tapping into the global case based reasoning database aka Google driven journal case report searching! @PPM4
[29-03-2025 11.17] PPM 1: Today's update 65M
[29-03-2025 11.18] PPM 1: 👆 all elements of his case report are available above before we can collect the EMR summary after discharge.
[29-03-2025 09.53] PPM 1: The CT scans of the patient.
[01-04-2025 11.00] PPM 1: Post holiday Update:
@CR do we have his PaJR group? Will need to inquire where he is now!
I managed to get his ECGs during the last days of his admission from the Arogyashree counter here.
[01-04-2025 11.02] PPM 1: Appears to be very little changes in the last few days unlike what one would
expect in a STEMI! Was this pericarditis after all or STEMI (the ECG did evolve in the beginning)
with pericarditis? @~PPM 3 @~PPM4 @PPM2
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